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- Ahlström, Gerd, et al.
(author)
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Similarities and differences between China and Sweden regarding the core features of palliative care for people aged 60 or older : a systematic scoping review
- 2022
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In: BMC Palliative Care. - : Springer Science and Business Media LLC. - 1472-684X. ; 21
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Journal article (peer-reviewed)abstract
- BACKGROUND: Despite the increasing longevity of the world's population, with an unprecedented rise in the number of people who need palliative care (PC), there has been sparse research regarding palliative care for older people, especially when it comes to comparison of PC between healthcare systems and cultures. The aim of this systematic scoping review was to identify the characteristics of the body of literature and to examine the knowledge gaps concerning PC research for older people (> 60 years) in two healthcare systems and cultures, mainland China and Sweden.METHODS: The guidelines PRISMA (Preferred Reporting Items for Systematic Reviews), and PICOS (Patient/population, Intervention, Comparison/control, and Outcome) were used. Empirical studies on patients 60 years or older, next of kin or staff participating in a palliative care intervention or setting were included. They were conducted in mainland China or in Sweden during 2007-2019, were published in English and were extracted from seven databases: Embase, PubMed, Scopus, Cinahl, PsycInfo, Academic Search Complete and Cochrane Library. Two independent researchers conducted the selection of studies, data extraction and methodological evaluation. Any disagreements were resolved in consultation with a third researcher. The analysis was manifest directed content analysis based on PICOS domains.RESULTS: Of the 15 studies, four were from mainland China and 11 from Sweden. Both countries included older patients with cancer but also other end-stage diseases such as heart failure and dementia. The studies differed in design, method and the content of the interventions. The study in China based on traditional Chinese medicine concerns traditional Chinese folk music. The six qualitative studies from Sweden were evaluations of five interventions.CONCLUSIONS: Despite the high age of the participating patients, there was no focus on an ageing perspective concerning palliative care. To adapt to the changes taking place in most societies, future research should have increased focus on older persons' need for palliative care and should take account of issues concerning research ethics, ethnicity and culture.REGISTERED IN PROSPERO: CRD42020078685 , available from.
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| 3. |
- Johansson, Gerd, et al.
(author)
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Hemtjänstpersonalens arbetsmiljö och hälsa i fyra skånska kommuner
- 2021
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Reports (other academic/artistic)abstract
- I denna rapport presentas resultaten från en arbetsmiljöenkät som genomförts ihemtjänsten i fyra skånska kommuner (2 landsortskommuner, 1 medelstor stad, 1 storstad). Enkäten syftade till att brett kartlägga hemtjänstpersonalens arbetsmiljö, hälsa och välmående och är en del av det fyraåriga forskningsprojektet ”Att skapa en bättre arbetsmiljö i hemtjänsten - participativt förändringsarbete i praktiken”. Projektet har finansierats av Forskningsrådet för hälsa, arbetsliv och välfärd (FORTE).Totalt svarade 114 personer varav 99 var kvinnor, 14 män och en person som inte angivit kön på enkäten. Andelen av hemtjänstpersonalen som svarade på enkäten var 73%. Personerna svarade på frågor om övergripande arbetssituation inklusive ergonomiska förhållanden och psykosocial arbetsmiljö och om hälsa.De allra flesta (mer än 90%) uppgav att de trivs med sitt arbete och sin arbetsplats. De angav också att stämningen var god, att de kände en gemenskap på arbetsplatsen och upplevde ett stort stöd från sina arbetskamrater, vilket medför att de har möjlighet att få råd och att lära av andra. En majoritet uppgav att de också hade ett gott stöd från närmaste chef. Däremot upplevde de att de ganska sällan fick uppskattning eller belöning för sitt arbete. Det kan också noteras att två tredjedelar av deltagarna kände att de ville arbeta kvar på nuvarande arbetsplats om fem år.Hemtjänstpersonalen lyfter i sina enkätsvar främst fram tre problem i arbetet;bristen på vikarier, att tiden att ägna sig åt varje omsorgstagare är för kort samt att antalet omsorgstagare som varje person ska besöka under en vecka är för stort.Bristen på tid hos omsorgstagarna medför bl.a. att de inte hinner sköta andrakringuppgifter, att tiden att förflytta sig mellan olika omsorgstagare äts upp ochnågon tid för att kunna varva ner finns inte. Möjligen kan denna brist på mikropauser i vardagen bidra till både ökad stress och fysisk belastning.Av samtliga undersökningsdeltagare angav mer än hälften i sina enkätsvar attnuvarande arbete hade gjort deras hälsa något eller mycket sämre. Förekomsten av besvär från muskler och leder var anmärkningsvärt hög jämfört med andra yrkesgrupper och även jämfört med tidigare studier av personal inom hemtjänst. Det var särskilt vanligt med besvär från rygg och armbågar/händer.För bedömning av indikation för utmattning har tre olika instrument använts.Dessa visar att en fjärdedel till en tredjedel av de hemstjänstanställda rapporterarstress och/eller utmattningsreaktioner på en nivå som indikerar risk för utmattningssyndrom eller annan relaterad psykisk ohälsa om deras situation blir långvarig.Sammanfattningsvis anser vi att de positiva sociala aspekterna av arbetsmiljön iform av trivsel på arbetsplatsen, god gemenskap med stöd från både ledning ochkollegor betyder att bilden av hemtjänsten som en oattraktiv arbetsplats inte är entydig. Det finns resurser i organisationen och bland personalen som det går attbygga vidare på.Vad gäller individens fysiska och psykologiska arbetsmiljö ser vi dock ett antalutmaningar i form av hög fysisk belastning och risk för stress och utmattning. Allt detta måste åtgärdas för att öka attraktionen för yrket och minska riskerna för arbetsskador och sjukskrivning. Även om organisatoriska förändringar och användning av tekniska hjälpmedel i vissa fall kan minska problemen så måste det anställas fler personer för att personalen ska kunna ge omsorgstagarna den vård- och omsorg de behöver. För att fler personer ska välja att arbeta inom hemtjänst krävs också förbättrade anställningsförhållanden som tillsvidareanställning, förbättrade löneförmåner, möjlighet till fortbildning, en arbetsmiljö som inte påverkar hälsan negativt och möjlighet att påverka hur arbetet utförs.
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| 5. |
- Persson, Johanna, et al.
(author)
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A framework for participatory work environment interventions in home care - success factors and some challenges
- 2022
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In: BMC Health Services Research. - : Springer Nature. - 1472-6963. ; 22:1
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Journal article (peer-reviewed)abstract
- Background Home care is beset with work environment issues and high staff turnover, while research concerned with interventions to improve the work environment is sparse. Few of the existing interventions apply a participative approach, despite this being associated with more positive outcomes and sustainable change. This paper presents a framework, rooted in action research and action learning, for participatory work environment interventions in home care, and demonstrates how this framework has been implemented in four Swedish home care organizations. Methods The framework has three phases (pre-intervention, intervention planning and intervention implementation) and consists of cycles of action and reflection in three constellations: a group of researchers, a reference group with labour market organization representatives and home care managers, and intervention work groups in the home care organizations. The work was documented and analysed with focus on the realization of the framework and challenges that were met on the way. The interventions were evaluated using a pre-/post-test questionnaire design. Results Parts of the framework were successfully implemented. The pre-intervention phase and the intervention planning phase, with intervention work groups, worked well. All four groups identified one intervention relevant to their own context. However, only two of the proposed interventions were fully implemented and evaluated. The high staff and management turnover, and the high rate of organizational changes made it impossible to evaluate the interventions statistically. Yet, data from open-ended questions in the post questionnaire showed that the two implemented interventions were perceived as successful. Conclusions The participatory framework, presented in this paper, seems promising for work environment interventions in home care. The framework was designed to reduce the risk of known disturbances affecting the process in unstable organizations. Despite this, it proved challenging to execute the framework, and especially the interventions, due to changes happening at high speed. In the two cases where organizational changes were not dominating, the interventions were implemented successfully. While the prerequisites for participation and successful implementation could be improved somewhat, the main issue, the instability of the organizational context, is hard for researchers or the individual home care units to tackle alone.
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| 6. |
- Rydenfält, Christofer, et al.
(author)
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Exploring Local Initiatives to Improve the Work Environment : A Qualitative Survey in Swedish Home Care Practice
- 2021
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In: Home Health Care Management & Practice. - : SAGE Publications. - 1084-8223 .- 1552-6739. ; 33:3, s. 154-161
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Journal article (peer-reviewed)abstract
- Home care for the elderly constitutes a large and growing part of the social welfare system. Though, home care work is associated with a number of work environment-related challenges, including an increased risk for injuries, musculoskeletal disorders, high levels of sick leave and staff turnover, as well as stress and high workload, research is sparse. The present study explores local initiatives to improve the work environment initiated by the home care organizations themselves, and asks whether or not these initiatives affected gender equality. A qualitative web survey was sent to Swedish home care organizations, with open questions about change initiatives intended to have a positive effect on the work environment. There is an impressive amount of local work environment-related change initiatives going on. 80 categories of change initiatives were identified in answers from 178 units. However, these change initiatives were seldom evaluated or made accessible to stakeholders outside the organization. Main themes were concerned with work organization, digitalization, and planning, which largely follows trends in society (ie, digitalization, teamwork), rather than the actual needs identified by research (eg, musculoskeletal disorders). Despite apparent gender-related challenges, little of the work was associated with gender equality. The results indicates that there is a huge learning potential as the identified initiatives can serve as inspiration for others. However, to fully take advantage of these type of initiatives, more systematic evaluations are required.
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| 7. |
- Ahlström, Gerd, et al.
(author)
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Collaboration and guidelines for the coordination of health care for frail older persons with intellectual disability : A national survey of nurses working in municipal care
- 2021
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In: Nursing Open. - : Wiley. - 2054-1058. ; 8:3, s. 1369-1379
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Journal article (peer-reviewed)abstract
- Aims: To describe and compare perceptions of collaboration between care providers on the part of three groups of Registered Nurses working in municipal care and having particular responsibility concerning the care of frail older people with intellectual disability (ID); and, furthermore, to investigate the presence of and compliance with guidelines for the coordination of care. Design: National survey study with cross-sectional design. Methods: Nurses (N = 110) with key positions concerning people with ID answered a national questionnaire about collaboration, guidelines and coordinated individual plans. Descriptive and comparative statistical analyses were applied. Results: The meetings on cooperation and coordination of interventions were attended most frequently by nurses, and least frequently by social workers. The nurses were overall satisfied with the collaboration but perceived shortcomings in the case of inpatient and outpatient psychiatric care. Only in about half of the meetings for making care plans participated the people with intellectual disability and next of kin.
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| 8. |
- Ahlström, Gerd, et al.
(author)
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Quality of Life among Next of Kin of Frail Older People in Nursing Homes : An Interview Study after an Educational Intervention concerning Palliative Care
- 2022
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In: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 19:5
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Journal article (peer-reviewed)abstract
- One cornerstone of palliative care is improving the family’s quality of life (QoL). The principles of palliative care have not been sufficiently applied in nursing homes. The aim of this study was to investigate the experiences of QoL of next of kin of frail older persons in nursing homes after an educational intervention concerning palliative care. This qualitative interview study with 37 next of kin used an abductive design with deductive and inductive content analysis. The deductive analysis confirmed the three themes of QoL from the study before the implementation: (1) orientation to the new life-situation, (2) challenges in the relationship, and (3) the significance of the quality of care in the nursing home. The inductive analysis resulted in the sub-theme “Unspoken palliative care”. Being the next of kin of an older person living in a nursing home can be distressing despite round-the-clock care, so staff need to apply a more explicitly palliative care perspective. Future research needs to evaluate the influence of meaning-focused coping on next of kin’s QoL and integrate this knowledge in psychosocial interventions. Clinical Trial Database for Clinical Research: KUPA project NCT02708498.
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| 9. |
- Barregård, Lars, 1948, et al.
(author)
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Cadmium Exposure and Coronary Artery Atherosclerosis: A Cross-Sectional Population-Based Study of Swedish Middle-Aged Adults
- 2021
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In: Environmental health perspectives. - 1552-9924 .- 0091-6765. ; 129:6
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Journal article (peer-reviewed)abstract
- The general population is ubiquitously exposed to the toxic metal cadmium through the diet and smoking. Cadmium exposure is associated with increased morbidity and mortality in myocardial infarction and stroke. Atherosclerosis is the main underlying mechanism of myocardial infarction. However, associations between cadmium and coronary artery atherosclerosis have not been examined.Our study sought to examine the hypothesis that blood cadmium (B-Cd) is positively associated with coronary artery calcification, as a measure of coronary artery atherosclerosis in the population-based Swedish SCAPIS study.Our analysis included 5,627 individuals (51% women), age 50-64 y, enrolled from 2013 to 2018. The coronary artery calcium score (CACS) was obtained from computed tomography. Blood cadmium was determined by inductively coupled plasma mass spectrometry (ICP-MS). Associations between B-Cd and coronary artery calcium score (CACS Agatston score) were evaluated using prevalence ratios (PRs) in models adjusted for sex, age, smoking, hypertension, diabetes, low-density cholesterol/high-density cholesterol ratio, and family history.The median B-Cd concentration was 0.24 μ g / L . The prevalence of positive coronary artery calcium ( CACS > 0 ) was 41% and the prevalence of CACS ≥ 100 was 13%. Relative to the lowest quartile (Q) of B-Cd ( < 0.16 μ g / L ), the highest quartile (median 0.63 μ g / L ) was associated with a small but significant increase in CACS > 0 (PR 1.1; 95% CI: 1.0, 1.3), and a greater relative increase in CACS ≥ 100 (PR 1.6; 95% CI: 1.3, 2.0). When restricted to 2,446 never-smokers, corresponding PRs were 1.1 (95% CI 0.9, 1.3) for CACS > 0 (63 cases in Q4) and 1.7 (95% CI 1.1, 2.7) for CACS ≥ 100 (17 cases in Q4).Blood cadmium in the highest quartile was associated with CACS in a general population sample with low to moderate cadmium exposure. This supports the hypothesis that atherosclerosis is an important mechanism underlying the associations between cadmium and incident cardiovascular disease. The findings suggest that public health measures to reduce cadmium exposure are warranted. https://doi.org/10.1289/EHP8523.
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| 10. |
- Brunkwall, Louise, et al.
(author)
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The Malmö Offspring Study (MOS) : design, methods and first results.
- 2021
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In: European Journal of Epidemiology. - : Springer Nature. - 0393-2990 .- 1573-7284. ; 36, s. 103-116
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Journal article (peer-reviewed)abstract
- As cardio metabolic disease manifestations tend to cluster in families there is a need to better understand the underlying mechanisms in order to further develop preventive strategies. In fact, genetic markers used in genetic risk scores, important as they are, will not be able alone to explain these family clusters. Therefore, the search goes on for the so called missing heritability to better explain these associations. Shared lifestyle and social conditions in families, but also early life influences may be of importance. Gene-environmental interactions should be explored. In recent years interest has grown for the role of diet-microbiota associations, as microbiota patterns may be shared by family members. In the Malmö Offspring Study that started in 2013, we have so far been able to examine about 4700 subjects (18-71 years) representing children and grandchildren of index subjects from the first generation, examined in the Malmö Diet Cancer Study during 1991 to 1996. This will provide rich data and opportunities to analyse family traits of chronic disease across three generations. We will provide extensive genotyping and phenotyping including cardiovascular and respiratory function, as well as markers of glucose metabolism. In addition, also cognitive function will be assessed. A 4-day online dietary recall will be conducted and gut as well as oral microbiota analysed. The ambition is to provide one of the first large-scale European family studies with individual data across three generations, which could deepen our knowledge about the role of family traits for chronic disease and its underlying mechanisms.
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